General Surgery’s Josh Bleicher spent twelve months tackling opioid prescribing patterns in hospital patients discharged after elective general surgery. What did his team find? We need a more patient-centered approach to opioid prescribing.

1. Discharge Prescriptions:
Do They Correlate with Patient Needs?
Josh Bleicher, MD MS

2. Problem Statement
Are discharge prescriptions appropriate and personalized for
individual patients and their actual pain requirements?
• Elective procedures in the general surgery department requiring inpatient admission
post-operatively
• CPT Codes for RYGB, Distal pancreatectomy and Whipple, Partial or total
colectomy (lap or open), AWR
• 09/2017 – 12/2017

3. Are discharge prescriptions appropriate and personalized for
individual patients and their actual pain requirements?
Problem Statement
• Morphine Equivalents Used in 24 and 48 hr time period prior to discharge
• Morphine Equivalents of Discharge Script
• Discharge prescriber – Intern, Senior, APC, etc.

4. Problem Statement
Are discharge prescriptions appropriate and personalized for
individual patients and their actual pain requirements?

8. Problem Statement
Are discharge prescriptions appropriate and personalized for
individual patients and their actual pain requirements?

9. Process Map
Surgery
Inpatient Pain
Management
Discharge
Goals Met
Discharge
Orders
Lap vs Open
and other
procedure details
Attending
Preferences:
Epidural, Blocks,
APS, adjuncts,
etc.
Personal Patient
Attributes:
Chronic pain,
home meds, etc.
?
Attending
Anesthesia
Residents
Attending
APCs
Resident or
APC (usually
Junior)

10. Next Steps
• Complete Analysis
• Develop Solution:
• Team Approach: Pharmacy, Residents/APCs, EPIC Staff
• Education
• Increased visibility of patient pain use when writing d/c orders
• Develop guidelines
• Monitor effectiveness

11. To learn more, visit:
uofuhealth.utah.edu/accelerate